SURGICAL POLICY IN PATIENTS AGED 70 YEARS AND OVER PRESENTING WITH GRADE IV CHRONIC ISCHAEMIA OF LOWER LIMBS

Ismailov N.B., Vesnin A.V.
Chair of General Surgery under the I. M. Sechenov Moscow Medical Academy
Hospital of War Veterans №2,
Moscow, Russia

The present work deals with a currently important problem concerning surgical decisionmaking in treatment of lowerlimb critical ischaemia in elderly and aged people. A total of fiftythree 70 andmoreyearold patients presenting with an ulcerativeandnecrotic lesion of soft tissue of the crus and foot underwent treatment at Hospital of War Veterans №2. They were subdivided into two groups depending on the level (height) of occlusion, and each of the groups was further subdivided into subgroups of patients subjected to the classical for the given localization of the lesion shunting operations, to compare the latter with less traumatic but at the same time less effective minor and nonanatomical reconstructions. Statistical analysis of the therapeutic outcomes in the immediate and remote (2 year) followup period revealed that comparing the iliacfemoral and cross femorofemoral reconstructions, the best results were obtained after extraanatomical operations. While comparing the femoropopliteal bypasses and profundoplasty showed that the obtained therapeutic outcomes were similar with certain advantage of the routinely performed shmting reconstructions. Based on the obtained findings, a conclusion was made on efficacy the principle of not maximal but sufficient revascularisation of lowerlimb tissues owing to a predominant use of minor and nonanatomical reconstructions.

KEY WORDS: arterial reconstructive operation, atherosclerosis obliterans of the lowerlimb arteries, gerontological patient, chronic critical ischaemia of lower limbs.

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